Elsevier

The Lancet

Volume 388, Issue 10057, 5–11 November 2016, Pages 2272-2281
The Lancet

Articles
Interventions to prevent and reduce physician burnout: a systematic review and meta-analysis

https://doi.org/10.1016/S0140-6736(16)31279-XGet rights and content

Summary

Background

Physician burnout has reached epidemic levels, as documented in national studies of both physicians in training and practising physicians. The consequences are negative effects on patient care, professionalism, physicians’ own care and safety, and the viability of health-care systems. A more complete understanding than at present of the quality and outcomes of the literature on approaches to prevent and reduce burnout is necessary.

Methods

In this systematic review and meta-analysis, we searched MEDLINE, Embase, PsycINFO, Scopus, Web of Science, and the Education Resources Information Center from inception to Jan 15, 2016, for studies of interventions to prevent and reduce physician burnout, including single-arm pre-post comparison studies. We required studies to provide physician-specific burnout data using burnout measures with validity support from commonly accepted sources of evidence. We excluded studies of medical students and non-physician health-care providers. We considered potential eligibility of the abstracts and extracted data from eligible studies using a standardised form. Outcomes were changes in overall burnout, emotional exhaustion score (and high emotional exhaustion), and depersonalisation score (and high depersonalisation). We used random-effects models to calculate pooled mean difference estimates for changes in each outcome.

Findings

We identified 2617 articles, of which 15 randomised trials including 716 physicians and 37 cohort studies including 2914 physicians met inclusion criteria. Overall burnout decreased from 54% to 44% (difference 10% [95% CI 5–14]; p<0·0001; I2=15%; 14 studies), emotional exhaustion score decreased from 23·82 points to 21·17 points (2·65 points [1·67–3·64]; p<0·0001; I2=82%; 40 studies), and depersonalisation score decreased from 9·05 to 8·41 (0·64 points [0·15–1·14]; p=0·01; I2=58%; 36 studies). High emotional exhaustion decreased from 38% to 24% (14% [11–18]; p<0·0001; I2=0%; 21 studies) and high depersonalisation decreased from 38% to 34% (4% [0–8]; p=0·04; I2=0%; 16 studies).

Interpretation

The literature indicates that both individual-focused and structural or organisational strategies can result in clinically meaningful reductions in burnout among physicians. Further research is needed to establish which interventions are most effective in specific populations, as well as how individual and organisational solutions might be combined to deliver even greater improvements in physician wellbeing than those achieved with individual solutions.

Funding

Arnold P Gold Foundation Research Institute.

Introduction

Physician burnout, a work-related syndrome involving emotional exhaustion, depersonalisation, and a sense of reduced personal accomplishment,1 has reached epidemic levels, with prevalences near or exceeding 50%, as documented in national studies of both physicians in training2, 3 and practising physicians.4, 5, 6 Consequences are negative effects on patient care,7, 8, 9 professionalism,10, 11 physicians’ own care and safety (including diverse issues such as mental health concerns and motor vehicle crashes),12, 13 and the viability of health-care systems, including reductions in physicians’ professional work effort.14, 15 Evidence has linked 1 point changes in burnout scores with meaningful differences in self-perceived major medical errors,8, 9 reductions in work hours,15 and suicidal ideation.12 These concerns have prompted calls for increased attention to physician wellbeing, including efforts targeting burnout.16, 17, 18 Both individual-focused and structural or organisational solutions are required.16 A more complete understanding than at present of the quality and outcomes of the literature on approaches to prevent and reduce burnout is necessary to understand the best evidence for effective interventions and to establish a strong foundation for further research to fill gaps in this literature.

Previous reviews of physician distress have been limited in their ability to inform these issues by a combination of factors, such as an absence of focus on physicians and burnout and inconsistent adherence to modern methodological systematic review standards.19, 20, 21, 22 Therefore, we did a systematic review and meta-analysis adhering to methodological standards to examine the literature to date on interventions to prevent and reduce physician burnout.

Section snippets

Search strategy and selection criteria

In this systematic review and meta-analysis (reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement23), we did a literature search to identify studies of interventions to prevent and reduce physician burnout, with the aid of an experienced medical librarian (PJE). We included studies collecting comparative data to assess the effect of an intervention on physician burnout, excluding studies of medical students and non-physician health-care

Results

Our search strategy identified 2617 articles, of which 230 met the criteria for full-text review (figure 1). The characteristics of the included studies are summarised in the appendix. 15 randomised controlled trials including 716 physicians27, 28, 29, 30, 31, 32, 33, 34, 35, 36, 37, 38, 39, 40, 41 and 37 unique cohort studies including 2914 physicians42, 43, 44, 45, 46, 47, 48, 49, 50, 51, 52, 53, 54, 55, 56, 57, 58, 59, 60, 61, 62, 63, 64, 65, 66, 67, 68, 69, 70, 71, 72, 73, 74, 75, 76, 77, 78

Discussion

Most studies in this systematic review and meta-analysis reported on changes in burnout domain scores, finding a significant reduction in emotional exhaustion and depersonalisation scores. Fewer studies reported on changes in overall burnout or high burnout levels in each domain than on changes in burnout domain scores, finding a significant reduction in absolute burnout and in a high degree of emotional exhaustion and depersonalisation. These effects were consistent between randomised

References (80)

  • CP West et al.

    Quality of life, burnout, educational debt, and medical knowledge among internal medicine residents

    JAMA

    (2011)
  • TD Shanafelt et al.

    Burnout and career satisfaction among American surgeons

    Ann Surg

    (2009)
  • TD Shanafelt et al.

    Burnout and satisfaction with work-life balance among US physicians relative to the general US population

    Arch Intern Med

    (2012)
  • AM Fahrenkopf et al.

    Rates of medication errors among depressed and burnt out residents: prospective cohort study

    BMJ

    (2008)
  • CP West et al.

    Association of resident fatigue and distress with perceived medical errors

    JAMA

    (2009)
  • TD Shanafelt et al.

    Burnout and medical errors among American surgeons

    Ann Surg

    (2010)
  • CP West et al.

    Physician well-being and professionalism

    Minn Med

    (2007)
  • LN Dyrbye et al.

    Relationship between burnout and professional conduct and attitudes among US medical students

    JAMA

    (2010)
  • TD Shanafelt et al.

    Special report: suicidal ideation among American surgeons

    Arch Surg

    (2011)
  • LN Dyrbye et al.

    Physician burnout: a potential threat to successful health care reform

    JAMA

    (2011)
  • T Bodenheimer et al.

    From Triple to Quadruple Aim: care of the patient requires care of the provider

    Ann Fam Med

    (2014)
  • R Sikka et al.

    The Quadruple Aim: care, health, cost and meaning in work

    BMJ Qual Saf

    (2015)
  • NK Thomas

    Resident burnout

    JAMA

    (2004)
  • C Regehr et al.

    Interventions to reduce the consequences of stress in physicians: a review and meta-analysis

    J Nerv Ment Dis

    (2014)
  • JH Ruotsalainen et al.

    Preventing occupational stress in healthcare workers

    Cochrane Database Syst Rev

    (2015)
  • D Moher et al.

    Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement

    BMJ

    (2009)
  • DA Cook et al.

    Current concepts in validity and reliability for psychometric instruments

    Am J Med

    (2006)
  • JP Higgins et al.

    The Cochrane Collaboration’s tool for assessing risk of bias on randomised trials

    BMJ

    (2011)
  • JA Sterne et al.

    A Cochrane Risk Of Bias Assessment Tool: for Non-Randomised Studies of Interventions (ACROBAT-NRSI), Version 1.0.0

  • D Oman et al.

    Passage meditation reduces perceived stress in health professionals: a randomized, controlled trial

    J Consult Clin Psychol

    (2006)
  • MM Rowe

    Four-year longitudinal study of behavioral changes in coping with stress

    Am J Health Behav

    (2006)
  • P Butow et al.

    Increasing oncologists’ skills in eliciting and responding to emotional cues: evaluation of a communication skills training program

    Psychooncology

    (2008)
  • JM Milstein et al.

    Burnout assessment in house officers: evaluation of an intervention to reduce stress

    Med Teach

    (2009)
  • I Bragard et al.

    Efficacy of a communication and stress management training on medical residents’ self-efficacy, stress to communicate and burnout

    J Health Psychol

    (2010)
  • AE Martins et al.

    Impact of a brief intervention on the burnout levels of pediatric residents

    J Pediatr (Rio J)

    (2011)
  • BP Lucas et al.

    Effects of 2- vs 4-week attending physician inpatient rotations on unplanned patient revisits, evaluations by trainees, and attending physician burnout: a randomized trial

    JAMA

    (2012)
  • K Moody et al.

    Helping the helpers: mindfulness training for burnout in pediatric oncology—a pilot program

    J Pediatr Oncol Nurs

    (2013)
  • CP West et al.

    Intervention to promote physician well-being, job satisfaction, and professionalism: a randomized clinical trial

    JAMA Intern Med

    (2014)
  • N Gunasingam et al.

    Reducing stress and burnout in junior doctors: the impact of debriefing sessions

    Postgrad Med J

    (2015)
  • M Linzer et al.

    A cluster randomized trial of interventions to improve work conditions and clinician burnout in primary care: results from the Health Work Place (HWP) study

    J Gen Intern Med

    (2015)
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